Participant's Name
*
First Name
Last Name
Gender
*
Male
Female
Prefer not to say
Date of Birth
*
MM
DD
YYYY
Participant's Phone
Optional for youth (1st-8th grade). Required for high school (9th-12th grade).
(###)
###
####
Health Notes
Are there any medical conditions that we should know about?
Mother's Name
First Name
Last Name
Mother's Phone
(###)
###
####
Father's Name
First Name
Last Name
Father's Phone
(###)
###
####
Experience
*
Has your child played basketball anywhere else? If so, where?
Referral Source
How did you hear about us?
General Liability Waiver
*
For my child (Participant) being allowed to participate in the LA Select Basketball LLC (the Program) I release and agree not to sue the program, its members, and their employees, sub-contractors, sponsors, agents, and affiliates from all present and future claims that may be made by the Participant or me, my family, estate, heirs, or assigns for property damage, or personal injury arising as a result of the Participants participation in the Program, and caused by the ordinary negligence of the parties listed above, wherever, whenever, or however the same may occur. I understand and agree that those listed above are not responsible for any injury or property damage arising about of the Program, even if caused by their ordinary negligence. I understand that participation in the Program involves certain risks, including, but not limited to serious injury. I am voluntarily allowing Participant to participate in the Program with knowledge of the danger involved and agree to accept all risks of such participation.
I certify that the participant is in excellent physical health and may participate in strenuous physical activities, including basketball to be played in the program. I also certify that the participant has permission to be transported by members of the program. Permission is granted for participant to receive emergency medical treatment, if needed. I also agree to indemnify and hold harmless those listed above for all claims arising out of Participants participation in the Program and all related activities. I agree to let the parties use Participants name and likeness free of charge in any manner and for any purpose without compensation to Participant or me. I understand that this document is intended to be as broad and inclusive as permitted by the laws of the state in which the Program is taking place and agree that if any portion of the agreement is invalid, that the remainder will continue in full legal force and effect. I further agree that any legal proceedings related to this waiver will take place in the state of California.
I am the parent or legal guardian of the Participant. I am of legal age and am freely signing this agreement. I have read this form and understand that by signing this form, I am giving up legal rights and remedies. I represent that I am parent/legal guardian of the child named above, and agree that the terms of this release are binding on the Participant and me.
I/we the Parents/legal Guardian of the above named Participant in the LA Select Basketball LLC hereby give my/our approval to their participation in any and all activities during the season. I/We assume all risks and hazards incidental to such participation, including transportation to and from all activities. I/We hereby waive, release, absolve, indemnify and agree to hold harmless the LA Select Basketball LLC Program, its organizers, sponsors, supervisors, board members, other participants, and any persons transporting the Participant, except the extent and in the amount covered by accidental or liability insurance.
I/We by signing below authorize LA Select Basketball LLC to input the above named Participants information into the LA Select Basketball LLC database. I/We understand that this information may have to be sent electronically and I/We will not hold LA Select Basketball LLC responsible for the security of such transmission. I/We allow pictures of the Participant to be posted online on the program’s websites.
Terms and Conditions
*
1. Acceptance of Terms - By engaging in any LA Select Basketball LLC activities, you agree to adhere to and be bound by these Terms of Service.
2. Participant Information - We collect participant information for program administration purposes only. By enrolling, you grant LA Select Basketball LLC permission to use this information responsibly and in accordance with relevant privacy laws.
3. Parental Responsibility - Parents/legal guardians are responsible for supervising their child during program participation and ensuring their compliance with safety guidelines and rules.
4. Emergency Medical Treatment - Participants have permission to receive emergency medical treatment if needed. Parents/legal guardians are responsible for providing accurate and updated emergency contact information.
5. Use of Participant's Name and Likeness - By enrolling, you grant LA Select Basketball LLC permission to use the participant's name and likeness for promotional and informational purposes without charge.
6. Privacy and Data Protection - We are committed to safeguarding your privacy. Any personal information collected will be used solely for program-related purposes and will not be shared with third parties without your explicit consent.
7. Consent for Online Postings - You provide consent for participant pictures to be posted online on our program's website and social media for promotional and informational purposes.
8. Updates to Terms - LA Select Basketball LLC reserves the right to update these Terms of Service. You will be notified of any material changes, and your continued participation constitutes acceptance of the updated terms.
